Reserve parenteral iron for those unable to absorb oral iron or with increasing anemia despite adequate doses of oral iron

Reserve transfusion of packed RBCs for those experiencing significant acute bleeding or in danger of hypoxia or coronary insufficiency

Clinical images

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Koilonychia: abnormalfingernail shape

Atrophic glossitis

Peripheral smear description

For anemia due to hemorrhage, maximal changes in RBC cellular indices occur by 120 days, when all normal erythrocytes produced prior to hemorrhage are replaced by microcytes

Before this, the peripheral smear shows a dimorphic population of erythrocytes: normocytic cells produced before bleeding and microcytic cells produced after bleeding - this is reflected in the red blood cell distribution width (RDW)

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